Background:A patient-specific computer simulation of transcatheter aortic valve replacement (TAVR) in tricuspid aortic valve has been developed, which can predict paravalvular regurgitation and conduction disturbance. We wished to validate a patient-specific computer simulation of TAVR in bicuspid aortic valve and to determine whether patient-specific transcatheter heart valve (THV) sizing and positioning might improve clinical outcomes.Methods:A retrospective study was performed on TAVR in bicuspid aortic valve patients that had both pre- and postprocedural computed tomography imaging. Preprocedural computed tomography imaging was used to create finite element models of the aortic root. Finite element analysis and computational fluid dynamics was performed. The simulation output was compared with postprocedural computed tomography imaging, cineangiography, echocardiography, and electrocardiograms. For each patient, multiple simulations were performed, to identify an optimal THV size and position for the patient’s specific anatomic characteristics.Results:A total of 37 patients were included in the study. The simulations accurately predicted the THV frame deformation (minimum-diameter intraclass correlation coefficient, 0.84; maximum-diameter intraclass correlation coefficient, 0.88; perimeter intraclass correlation coefficient, 0.91; area intraclass correlation coefficient, 0.91), more than mild paravalvular regurgitation (area under the receiver operating characteristic curve, 0.86) and major conduction abnormalities (new left bundle branch block or high-degree atrioventricular block; area under the receiver operating characteristic curve, 0.88). When compared with the implanted THV size and implant depth, optimal patient-specific THV sizing and positioning reduced simulation-predicted paravalvular regurgitation and markers of conduction disturbance.Conclusions:Patient-specific computer simulation of TAVR in bicuspid aortic valve may predict the development of important clinical outcomes, such as paravalvular regurgitation and conduction abnormalities. Patient-specific THV sizing and positioning may improve clinical outcomes of TAVR in bicuspid aortic valve.

中文翻译：

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二尖瓣主动脉瓣形态在经导管主动脉瓣置换中的患者特定计算机模拟。

背景：已开发了针对特定患者的三尖瓣主动脉瓣膜置换术（TAVR）的计算机模拟，可以预测瓣周关闭不全和传导障碍。我们希望验证二尖瓣主动脉瓣膜TAVR的患者特定计算机模拟，并确定患者特定的经导管心脏瓣膜（THV）的尺寸和位置是否可以改善临床结果。方法：对二尖瓣主动脉瓣膜TAVR进行了回顾性研究。术前和术后均进行了计算机断层扫描成像的患者。术前计算机断层扫描成像用于创建主动脉根的有限元模型。进行了有限元分析和计算流体动力学。将模拟输出与过程后计算机断层摄影成像进行比较，电影血管造影，超声心动图和心电图。对于每位患者，进行了多次模拟，以根据患者的特定解剖特征确定最佳的THV大小和位置。结果：总共纳入了37位患者。该模拟准确地预测了THV框架变形（最小直径组内相关系数为0.84;最大直径组内相关系数为0.88;周围组内相关系数为0.91;区域组内相关系数为0.91），超过了轻度瓣周返流（面积下的反流）。接收器工作特性曲线为0.86）和主要传导异常（新的左束支传导阻滞或高度房室传导阻滞；接收器工作特性曲线下方的面积为0.88）。与植入的THV大小和植入深度相比，最优的患者特定THV尺寸和位置减少了模拟预测的瓣周关闭不全和传导障碍的标志。临床结果，如瓣周关闭不全和传导异常。特定于患者的THV大小和位置可能会改善双尖瓣主动脉TAVR的临床结局。如瓣周关闭不全和传导异常。特定于患者的THV大小和位置可能会改善双尖瓣主动脉TAVR的临床结局。如瓣周关闭不全和传导异常。特定于患者的THV大小和位置可能会改善双尖瓣主动脉TAVR的临床结局。